Post-exercise high-sensitivity troponin T levels in patients with suspected unstable angina


Autoři: Gaetano Antonio Lanza aff001;  Erica Mencarelli aff001;  Veronica Melita aff001;  Antonio Tota aff002;  Maurizio Gabrielli aff002;  Filippo Sarullo aff003;  Chiara Cordischi aff002;  Annalisa Potenza aff002;  Silvia Cardone aff002;  Antonio De Vita aff001;  Antonio Bisignani aff001;  Laura Manfredonia aff001;  Giuseppa Caccamo aff003;  Giuseppe Vitale aff003;  Silvia Baroni aff004;  Mirca Antenucci aff004;  Filippo Crea aff001;  Francesco Franceschi aff002
Působiště autorů: Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Department of Cardiovascular Disease, Roma, Italy aff001;  Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Department of Emergency Medicine, Roma, Italy aff002;  Ospedale Buccheri La Ferla, Cardiac Rehabilitation Unit, Palermo, Italy aff003;  Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Department of Clinical Chemistry, Roma, Italy aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222230

Souhrn

Background

Previous studies showed that troponin blood levels may increase after exercise. In this study we assessed whether, among patients admitted with suspected unstable angina, the increase in high-sensitive troponin T (hs-TnT) levels after exercise stress test (EST) might help identify those with obstructive coronary artery disease (CAD) and predict symptom recurrence during short term follow-up.

Methods

Maximal treadmill EST was performed in 69 consecutive patients admitted to the emergency room with a suspicion of unstable angina (acute chest pain but confirmed normal serum levels of cardiac troponins) was measured before and 4 hours after EST. Coronary angiography was performed in 22 patients (32.8%).

Results

hs-TnT increased after EST compared to baseline in the whole population (from 0.84±0.65 to 1.17±0.87 ng/dL, p<0.001). The increase was similar in patients with positive (n = 14) and negative (n = 55) EST (p = 0.72), and was also similar in patients with (n = 12) and without (n = 10) obstructive CAD at angiography (p = 0.91). The achievement of a heart rate at peak EST ≥85% of that predicted for age was the variable mainly associated with the post-EST hs-TnT increase at multivariable linear regression analysis (p = 0.005). The change after EST of hs-TnT did not predict the recurrence of symptoms or readmission for chest pain at 6-month follow-up.

Conclusions

Our data show that hs-TnT increased after EST in patients with suspected unstable angina, which seemed largely independent of most clinical and laboratory variables. Thus, hs-TnT assessed after EST does not seem to be helpful to identify patients with obstructive CAD in this kind of patients.

Klíčová slova:

Biology and life sciences – Biochemistry – Proteins – Cytoskeletal proteins – Troponin – Medicine and health sciences – Vascular medicine – Coronary heart disease – Angina – Ischemia – Cardiology – Cardiovascular medicine – Cardiovascular imaging – Angiography – Diagnostic medicine – Diagnostic radiology – Radiology and imaging – Endocrinology – Endocrine disorders – Metabolic disorders – Surgical and invasive medical procedures – Cardiovascular procedures – Angioplasty – Coronary angioplasty – Research and analysis methods – Imaging techniques – Bioassays and physiological analysis – Electrophysiological techniques – Cardiac electrophysiology – Electrocardiography


Zdroje

1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72:2231–2264. doi: 10.1016/j.jacc.2018.08.1038 30153967

2. Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858–67. doi: 10.1056/NEJMoa0900428 19710484

3. Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA, et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012;60:2427–63. doi: 10.1016/j.jacc.2012.08.969 23154053

4. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32:404–11. doi: 10.1093/eurheartj/ehq456 21169615

5. Turer AT, Addo TA, Martin JL, Sabatine MS, Lewis GD, Gerszten RE, et al. M Myocardial ischemia induced by rapid atrial pacing causes troponin T release detectable by a highly sensitive assay: insights from a coronary sinus sampling study. J Am Coll Cardiol. 2011;57:2398–405. doi: 10.1016/j.jacc.2010.11.066 21658559

6. White HD. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J Am Coll Cardiol. 2011 Jun;57:2406–8. doi: 10.1016/j.jacc.2011.01.029 21658560

7. Hickman PE, Potter JM, Aroney C, Koerbin G, Southcott E, Wu AH, et al. Cardiac troponin may be released by ischemia alone, without necrosis. Clin Chim Acta. 2010;411:318–23. doi: 10.1016/j.cca.2009.12.009 20036224

8. Røysland R, Kravdal G, Høiseth AD, Nygård S, Badr P, Hagve TA, et al. Cardiac troponin T levels and exercise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study. Clin Sci. 2012;122:599–606. doi: 10.1042/CS20110557 22239123

9. Blatt A, Moravsky G, Pilipodi S, Mor A, Benbeniste P, Vered Z, et al. Can dobutamine stress echocardiography induce cardiac troponin elevation? Echocardiography. 2011;28:219–22. doi: 10.1111/j.1540-8175.2010.01299.x 21198823

10. Kurz K, Giannitsis E, Zehelein J, Katus HA. Highly sensitive cardiac troponin T values remain constant after brief exercise- or pharmacologic-induced reversible myocardial ischemia. Clin Chem. 2008;54:1234–8. doi: 10.1373/clinchem.2007.097865 18593962

11. Røsjø H, Kravdal G, Høiseth AD, Jørgensen M, Badr P, Røysland R, et al. Troponin I measured by a high-sensitivity assay in patients with suspected reversible myocardial ischemia: data from the Akershus Cardiac Examination (ACE) 1 study. Clin Chem. 2012;58:1565–73. doi: 10.1373/clinchem.2012.190868 22997281

12. Jarolim P, Morrow DA. Use of high sensitivity cardiac troponin assays as an adjunct to cardiac stress testing. Clin Biochem. 2016;49:419–420. doi: 10.1016/j.clinbiochem.2016.03.001 26969798

13. Shave R, Baggish A, George K, Wood M, Scharhag J, Whyte G, et al. Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications. J Am Coll Cardiol. 2010;56:169–76. doi: 10.1016/j.jacc.2010.03.037 20620736

14. Li F, Yi L, Yan H, Wang X, Nie J, Zhang H, et al. High-sensitivity cardiac troponin T release after a single bout of high-intensity interval exercise in experienced marathon runners. J Exerc Sci Fit. 2017;15:49–54. doi: 10.1016/j.jesf.2017.08.001 29541132

15. Skadberg Ø, Kleiven Ø, Ørn S, Bjørkavoll-Bergseth MF, Melberg TH, Omland T, et al. The cardiac troponin response following physical exercise in relation to biomarker criteria for acute myocardial infarction; the North Sea Race Endurance Exercise Study (NEEDED) 2013. Clin Chim Acta. 2018;479:155–159. doi: 10.1016/j.cca.2018.01.033 29366834

16. Hammadah M, Al Mheid I, Wilmot K, Ramadan R, Alkhoder A, Obideen M, et al. Association Between High-Sensitivity Cardiac Troponin Levels and Myocardial Ischemia During Mental Stress and Conventional Stress. JACC Cardiovasc Imaging. 2018;11:603–611. doi: 10.1016/j.jcmg.2016.11.021 28330661

17. Orsini E, Caravelli P, Dini FL, Marzilli M. High sensitivity cardiac troponins: Can they help in diagnosing myocardial ischaemia? Eur Heart J Acute Cardiovasc Care. 2017:2048872617700868.

18. Konishi M, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Matsubara J, et al. Basal and ischemia-induced transcardiac troponin release into the coronary circulation in patients with suspected coronary artery disease. PLoS One. 2013;8:e60163. doi: 10.1371/journal.pone.0060163 23565198

19. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al.; ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315. doi: 10.1093/eurheartj/ehv320 26320110

20. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139–e228. doi: 10.1016/j.jacc.2014.09.017 25260718

21. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the 1997 Exercise Testing Guidelines. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2002;40:1531–40. doi: 10.1016/s0735-1097(02)02164-2 12392846

22. Coplan NL, Wallach ID. The role of exercise testing for evaluating patients with unstable angina. Am Heart J. 1992;124:252–6. doi: 10.1016/0002-8703(92)90958-x 1615823

23. Schmid J, Liesinger L, Birner-Gruenberger R, Stojakovic T, Scharnagl H, Dieplinger B, et al. Elevated cardiac troponin T in patients with skeletal myopathies. J Am Coll Cardiol. 2018;71:1540–1549. doi: 10.1016/j.jacc.2018.01.070 29622161


Článek vyšel v časopise

PLOS One


2019 Číslo 9
Nejčtenější tento týden